Lyme Disease Treatment Failure in a Soldier
Lyme disease treatment failure can leave patients with persistent symptoms and uncertainty about diagnosis and care. In this Inside Lyme Podcast, I discuss the case of a 21-year-old soldier who was ultimately dismissed from active duty after failing treatment for several illnesses including Lyme disease.
This case was first described by Melanson and colleagues in the paper
“The Epistemic Fallacy: Unintended Consequences of Empirically Treating Chronic Lyme Disease in a Soldier.”1
Early Symptoms and Initial Evaluations
The patient was a 21-year-old Division 1 student athlete who presented with heart palpitations and frequent unprovoked adrenaline surges. His symptoms were initially attributed to stress.
Four months later, testing for Epstein-Barr virus (EBV) was positive, while Lyme disease serology was negative. The physicians diagnosed EBV reactivation and recommended rest and recovery.
Despite graduating, the young man remained on medical leave because his symptoms had not resolved.
Multiple Diagnoses Considered
Over time, physicians considered several possible explanations for his persistent symptoms.
He was presumed to have persistent mononucleosis-like symptoms and possible traumatic brain injury related to sports-associated concussion.
The patient also underwent hyperbaric oxygen therapy (HBOT). However, after two sessions the treatment was stopped because his symptoms worsened, including:
- Heart palpitations
- Flank pain
- Muscle pain
- Neuropathy
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Clinical Treatment for Lyme Disease
Although repeat Lyme disease tests remained negative, physicians treated the patient clinically for Lyme disease based on his symptoms, possible tick exposure during military training, and the lack of other clear diagnoses.
He received three courses of doxycycline, but subsequent Lyme testing remained inconclusive.
The patient was forced to stop treatment after worsening symptoms including joint pain, nerve pain, headache, fatigue, cognitive problems, anxiety, mild depression, and chest pain.
Additional Evaluations
The patient later consulted a functional medicine physician who evaluated him for mycotoxin exposure related to his living and training environments.
His workup revealed:
- A single nucleotide polymorphism in the MTHFR gene suggesting impaired detoxification
- An abnormal urine mycotoxin panel
He underwent treatment with IV phosphatidylcholine, IV glutathione, IV leucovorin, and subcutaneous vitamin B12 for three months. Although he experienced modest improvements in fatigue and stamina, treatment was discontinued due to cost.
A repeat urine mycotoxin panel later returned negative.
Persistent Symptoms
Despite multiple treatment approaches, the soldier remained significantly impaired.
He reported being unable to perform moderate physical exercise or cognitive work because of:
- Short-term memory impairment
- Difficulty concentrating
- Severe fatigue
- Post-exertional malaise
- Asthma and allergic reactions
- Chemical and food sensitivities
- Histamine intolerance
- Heat- or ultraviolet-induced urticaria
He also struggled with anxiety, depression, and sensitivity to environmental stimuli such as bright lights, flashing lights, and loud noise.
Final Diagnosis and Military Evaluation
The patient was eventually diagnosed with chronic fatigue syndrome / myalgic encephalomyelitis (CFS/ME) following resolution of acute mycotoxicosis.
The Army Medical Evaluation Board determined that he was unfit for duty because of:
- Lyme disease
- Mycotoxicosis
- Chronic fatigue syndrome
- Allergic rhinitis
- Vasomotor rhinitis
Despite extensive evaluations and treatment attempts, the soldier remained unable to return to active duty.
Questions Raised by This Case
- Have you seen patients with this range of symptoms?
- What role might hyperbaric oxygen therapy play in these cases?
- How is empiric treatment used when diagnostic testing is inconclusive?
- Could Lyme disease still be contributing to persistent symptoms?
- How often do patients with Lyme disease fail treatment?
- How frequently do overlapping illnesses complicate diagnosis?
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Thank you for listening to another Inside Lyme Podcast. The information provided here is general and not intended as specific medical advice. Patients should consult an experienced healthcare professional for individualized guidance.
Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.
Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention
Welcome to my life. The VA still denies I have Lyme, ME/CFS and now MCAS, etc after 6 years. Thank God for Medicare and NDs!
I am astounded this poor young man got this far. With diagnosis and that amount of treatment. For five years I’ve been literally begging my GP here in London UK to reckonise me. Yet that are flat refusing to even consider Lyme disease. I am now so sick I cannot work. I have no money for private treatment. I feel scared, alone and dismissed. As well as gaslighted into believing i have mental issues causing my symptoms. I am now desperate for help, I don’t know where to turn. To sick to even get up some days, let alone write emails of complaints. I did complain about one doctor who slapped my hand away. That just made it worst at now every GP in the surgery just roll their eyes and patronise me. I now have nothing but anger & frustration also added on top of everything else. The way they have treated me for five years has been appalling. When ever I can I’ve bought doxcycline from online. I’ve also bought iver mec to keep going. Also fen Ben.
Look for an attorney and let them fight for you, the VA does not like to recognize many illnesses.
Part of the problem are viral, bacterial infections plus parasite infestations. First thing to do is to start eating raw garlic every single day, two cloves. After that start drinking green tea two cups a day every single day plus start drinking Moringa tea infusions. Start eating oranges and red grapes and mushrooms. Find competent MD and ask him to give you prescription for Amoxicillin 750mg x 3 times a day for 7 days. Four week later you need prescription for Ciprofloxacin 250mg x 3 times a day for 5 days and you will be OK.
Dr. C, I wish you would have written the headline differently. Who failed? The soldier or the lyme treatment? You wrote the title as if the soldier if the failure. The failure is the lyme treatment’s failure and not the soldiers. With this title you are feeding the standard narrative that it is the patients failing. Patients aren’t failing…..the treatments are. And what a difference it would make if you had titled it as treatment’s fault rather than the soldier’s.